54 Y Female who will undergo vaginal hysterectomy along with some issues in the anal canal and bladder.
Medical History:
Atrial Fibrillation (Managed by Bisoprolol 2.5 mg once daily)
Chronic venous insufficiency (Managed by Daflon one tablet once daily)
Allergic Rhinitis (Managed by Cetirizine 10 mg once daily)
Non alcoholic fatty liver disease
Past (maybe relevant history) - She went 2 years ago to the ICU because she lost abnormal amounts of blood along with AFib episode which required blood transfusion, during her stay in the ICU, some symptoms and abnormalities occurred like Fever and Superficial thrombophlebitis.
Beside this, some signs and symptoms that the cardiologist agreed not to investigate the cause and there is no need to (After he investigated the Echocardiogram, Blood pressure, ECG : Occassional dyspnea, some symptoms that mimic coronary artery disease like Chest pain.
The Anesthesiologist plan according to this history and CBC and some questions that I can post answers to if you asked them:
General Anesthesia and she shouldn't discontinue Daflon and should take Enoxaparin two days consequently prior to the surgery.
My Q is, is prophylaxis using Enoxaparin considered to be good? Also what about Daflon, should she continue using it? Final one, does she need to stop dietary garlic 7 days prior to the surgery because the Anesthesiologist forgot to mention this one ?
My reply will be as follows:
1) if she is taking enoxaparin for prophylaxis, you may consider epidural anesthesia in accordance with the ASRA protocols.
Alternatively, if she is taking enoxaparin at treatment dose , general anesthesia can be combined with bilateral high lumbar erector spinae plane block.
2)In my personal openion Daflon can be stopped and elastic bandage or leg stockings can be used alternatively.
3) For sure garlic should be avoided 7-10 days before major surgery.
I hope it helps.
Best Regards
Thanks Dr.Mehmet. I have a few questions related to your answers. The ASA recommendation goes by stopping all herbal medicine (Image attached) prior to surgery but I found a study that recommend Daflon and LMWH prior to surgery (Image attached) What about the general anesthesia? Why you recommend epidural anesthesia and what could be the reason the
Anesthesiologist chose the general anesthesia? Also, what about dietary onion, do you recommend against dietary onion or not?
References:
Article Low-Molecular-Weight Heparins and Daflon for Prevention of P...
Article Perioperative anesthesia clinical considerations of alternat...
Mehmet Canturk
All,
Do we not encounter this problem daily or weekly? How long do we have between preoperative evaluation and DOS? Are we seeing the patient in the preoperative holding area? Time is the key in planning but not necessarily a game stopper if seen morning of surgery. If seen a week or more ahead, I concur with previous answers. If seen the morning of, GETA (probably TIVA) . Is this laparoscopic assisted? If so, bilateral erector spinae plane blocks for postoperative pain control.
Regards,
Christopher
Dr.Christopher, what about my Qs in the second comment? The daflon study, also what about the dietary onion? Christopher A Smith
My apologies,
I have no problem with dietary onions. Green onion is high in vitamin k, yellow and white onion can cause gas and bloating. I have not observed any clinical issues.... doesn’t mean that it couldn’t...
Cheers,
Christopher
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